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The purpose of this study is to clinically validate a series of circulating miRNAs that distinguish between the 4 most prevalent tumor types (lung cancer (LC), breast cancer (BC), colorectal cancer (CRC), and prostate cancer (PCa)) and healthy donors (HDs). A total of 18 miRNAs and 3 housekeeping miRNA genes were evaluated by qRT-PCR on RNA extracted from serum of cancer patients, 44 LC, 45 BC, 27 CRC, and 40 PCa, and on 45 HDs. The cancer detection performance of the miRNA expression levels was evaluated by studying the area under the curve (AUC) of receiver operating characteristic (ROC) curves at univariate and multivariate levels. miR-21 was significantly overexpressed in all cancer types compared with HDs, with accuracy of 67.5% (p = 0.001) for all 4 tumor types and of 80.8% (p &lt, 0.0001) when PCa cases were removed from the analysis. For each tumor type, a panel of miRNAs was defined that provided cancer-detection accuracies of 91%, 94%, 89%, and 77%, respectively. In conclusion, we have described a series of circulating miRNAs that define different tumor types with a very high diagnostic performance. These panels of miRNAs would constitute the basis of different approaches of cancer-detection systems for which clinical utility should be validated in prospective cohorts.

Introduction Endoscopic resection is the common treatment in pT1 colorectal adenocarcinoma whenever possible. The presence of adverse histological factors requires subsequent lymph node evaluation. Materials and methods We selected 29 colorectal pT1 adenocarcinoma including endoscopic polypectomies and the corresponding surgical specimens. All histologic parameters associated with N+ were evaluated by 2 pathologists, including: tumour differentiation grade, depth of invasion in the submucosa, angiolymphatic invasion (ALI), perineural invasion, chronic inflammation, tumour budding, poorly differentiated cluster, pre-existing adenoma, tumour border, and endoscopic resection margin. Univariate and multivariate logistic regression analysis was performed to assess the individual capacity of each variable to predict N+. Results In the univariate analysis, rectal tumour localization, ALI and poorly differentiated cluster were significantly associated with N+. Among the significant parameters, ALI had the highest area under the ROC curve (0.875). Multivariate analysis showed no independent variables associated with N+. Conclusions We confirm that ALI and the presence of poorly differentiated cluster are frequently associated with N+ in early colorectal cancer. Consequently, these parameters should be routinely evaluated by pathologists.

Resumen Introduccion El tratamiento habitual del adenocarcinoma colorrectal pT1 consiste en la reseccion endoscopica siempre que sea posible. Se requiere la evaluacion de los ganglios linfaticos locorregionales cuando se detectan factores histologicos adversos en las polipectomias endoscopicas. Materiales y metodos Se seleccionaron 29 adenocarcinomas colorrectales pT1 incluyendo las polipectomias endoscopicas y piezas quirurgicas correspondientes. Se evaluaron por 2 patologos todos los parametros histologicos asociados a N+, incluyendo: grado de diferenciacion tumoral, profundidad de invasion en submucosa, invasion angiolinfatica (IAL), invasion perineural, inflamacion cronica, gemaciones tumorales, grupos de tumor pobremente diferenciados, adenoma preexistente, borde tumoral y margen de reseccion endoscopico. Se realizo un analisis de regresion logistica univariante y multivariante para evaluar la capacidad individual de cada variable para predecir N+. Resultados En el analisis univariante, la localizacion rectal, la presencia de IAL y la presencia de grupos de tumor pobremente diferenciados se asociaron significativamente con metastasis ganglionares. De todas estas variables, la presencia de IAL presento la mayor area bajo la curva ROC (0,875). El analisis multivariante no encontro ninguna variable independiente asociada a N+. Conclusiones La IAL y la presencia de grupos de tumor pobremente diferenciados se asocia frecuentemente con N+ en cancer colorrectal precoz, por lo que se debe implementar rutinariamente la evaluacion de estos parametros histologicos.

A 69-year-old woman from a kindred with familial atypical multiple mole melanoma and carrier of a germline mutation in CDKN2A, presented with abdominal pain caused by a solid-cystic pancreatic mass. The patient had an abdominal computed tomography three years before in which there was no evidence of pancreatic lesion. The endoscopic ultrasound guided fine needle aspiration showed adenocarcinoma with squamous component. After surgical resection the final diagnosis was adenosquamous pancreatic carcinoma (ASPC) arising in an intraductal papillar mucinous neoplasm (IPMN). Adenosquamous carcinomas are uncommon in the pancreas and have rarely been described in association with IPMNs. It has worse prognosis than the ordinary pancreatic ductal adenocarcinoma and some distinct features. We review the clinical, imaging, pathologic and molecular aspects of ASPC. Differential diagnosis with contamination, squamous metaplasia and pancreatic metastases from a distant squamous carcinoma is discussed. Besides, the case is an accelerated model of the adenoma (IPMN)-carcinoma sequence probably due to the CDKN2A germline mutation. Somatic CDKN2A mutations are common events in the early steps of sporadic pancreatic cancer, but germline mutation carriers have a significantly higher risk of pancreatic carcinoma.